The Gluten-Free Diet: A Nutritional Risk Factor for Adolescents with Celiac Disease?

Abstract

In people with celiac disease, adherence to a strict gluten-free diet worsens the already nutritionally unbalanced diet of adolescents, increasing elevated protein and lipid consumption. In the follow-up of patients with celiac disease, considerable effort has yet to be made to improve compliance with a gluten-free diet, and especially to control the nutritional balance of the diet in compliant patients.

A Brazilian experience of the self transglutaminase-based test for celiac disease case finding and diet monitoring

“…However, antibody tests might not reveal slight dietary transgressions [25] . In the present experience, the Biocard test recognized the disappearance of anti-tTG antibodies in all the patients with a GFD compliance and was positive in 14% (6/43) of the patients who admitted transgressions: they were young patients (median age 24 years), confirming the reports that adolescents had difficulties adhering strictly to the diet [26][27][28] . The positivity of the test presumes major dietary transgressions [25] .…”

Celiac disease and obesity: need for nutritional follow-up after diagnosis

“…GFD seems to increase the risk of overweight or obesity, and concerns have been raised about the nutritional imbalance and hypercaloric content of commercial or natural gluten-free food. There is a trend, both in adults and in children, on a GFD to replace gluten-derived carbohydrates with an increased consumption of fats, proteins and hypercaloric beverages and to decrease fiber intake (Mariani et al, 1998;Dickey and Kearney, 2006;Ferrara et al, 2009). Incorrect dietary habits can be induced by unpalatability and expense of commercial gluten-free products or by the availability of commercial gluten-free snacks and biscuits with a high content of lipids.…”

“…Incorrect dietary habits can be induced by unpalatability and expense of commercial gluten-free products or by the availability of commercial gluten-free snacks and biscuits with a high content of lipids. Adolescents are likely to be at a higher risk of inappropriate and potentially harmful alimentary habits (Mariani et al, 1998). Dietary modifications are more troublesome in countries such as Italy, where people have a high gluten-containing diet (bread, pizza and pasta), but similar dietary imbalances have also been described in Dutch children with CD (Hopman et al, 2006).…”

“…Some reports in the literature also suggest that CD and obesity can coexist in both childhood and adolescence (Conti-Nibali et al, 1987;Franzese et al, 2001;Oso and Fraser, 2006;Arslan et al, 2009). Furthermore, patients with CD who have normal nutritional status, or are overweight at presentation, would be at further risk of obesity after gluten-free diet (GFD) because of improved intestinal absorption and unbalanced diet rich in lipids and proteins (Mariani et al, 1998;Dickey and Kearney, 2006).…”

Body mass index in celiac disease and effect of a gluten-free diet on body mass index

“…Mariani et al first reported high prevalence of overweight and obesity in CD adolescents on a gluten-free diet (GFD). 2 The risk of overweight and obesity at diagnosis of CD varies largely with the nutritional status of the underlying population, as suggested by some very recent pediatric papers.…”